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Observational Study
. 2021 Sep 13;25(1):331.
doi: 10.1186/s13054-021-03727-x.

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Antoni Torres #  1   2   3 , Anna Motos #  4   5 , Jordi Riera  6 , Laia Fernández-Barat #  4   5 , Adrián Ceccato #  4 , Raquel Pérez-Arnal  7 , Dario García-Gasulla  7 , Oscar Peñuelas  4   8 , José Angel Lorente  4   8 , Alejandro Rodriguez  9 , David de Gonzalo-Calvo  4   10 , Raquel Almansa  11   12 , Albert Gabarrús  5 , Rosario Menéndez  13 , Jesús F Bermejo-Martin  11   12 , Ricard Ferrer  6 , Rosario Amaya Villar  14 , José M Añón  4   15 , Carme Barberà  16 , José Barberán  17 , Aaron Blandino Ortiz  18 , Elena Bustamante-Munguira  19 , Jesús Caballero  20 , Cristina Carbajales  21 , Nieves Carbonell  22 , Mercedes Catalán-González  23 , Cristóbal Galbán  24 , Víctor D Gumucio-Sanguino  25   26 , Maria Del Carmen de la Torre  27 , Emili Díaz  28   29 , Ángel Estella  30 , Elena Gallego  31 , José Luis García Garmendia  32 , José Garnacho-Montero  33 , José M Gómez  34 , Arturo Huerta  35 , Ruth Noemí Jorge García  36 , Ana Loza-Vázquez  37 , Judith Marin-Corral  38 , Amalia Martínez de la Gándara  39 , Ignacio Martínez Varela  40 , Juan López Messa  41 , Guillermo M Albaiceta  4   42   43 , Mariana Andrea Novo  44 , Yhivian Peñasco  45 , Juan Carlos Pozo-Laderas  46 , Pilar Ricart  47 , Inmaculada Salvador-Adell  48 , Angel Sánchez-Miralles  49 , Susana Sancho Chinesta  50 , Lorenzo Socias  51 , Jordi Solé-Violan  52 , Fernando Suares Sipmann  53 , Luis Tamayo Lomas  54 , José Trenado  55 , Ferran Barbé  4   10 ; CIBERESUCICOVID Project (COV20/00110, ISCIII)
Collaborators, Affiliations
Observational Study

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Antoni Torres et al. Crit Care. .

Erratum in

  • Correction to: The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients.
    Torres A, Motos A, Riera J, Fernández-Barat L, Ceccato A, Pérez-Arnal R, García-Gasulla D, Peñuelas O, Lorente JA, Rodriguez A, de Gonzalo-Calvo D, Almansa R, Gabarrús A, Menéndez R, Bermejo-Martin JF, Ferrer R, Amaya Villar R, Añón JM, Barberà C, Barberán J, Blandino Ortiz A, Bustamante-Munguira E, Caballero J, Carbajales C, Carbonell N, Catalán-González M, Galbán C, Gumucio-Sanguino VD, de la Torre MDC, Díaz E, Estella Á, Gallego E, García Garmendia JL, Garnacho-Montero J, Gómez JM, Huerta A, Jorge García RN, Loza-Vázquez A, Marin-Corral J, Martínez de la Gándara A, Martínez Varela I, López Messa J, M Albaiceta G, Novo MA, Peñasco Y, Pozo-Laderas JC, Ricart P, Salvador-Adell I, Sánchez-Miralles A, Sancho Chinesta S, Socias L, Solé-Violan J, Suares Sipmann F, Tamayo Lomas L, Trenado J, Barbé F; CIBERESUCICOVID Project (COV20/00110, ISCIII). Torres A, et al. Crit Care. 2021 Dec 17;25(1):435. doi: 10.1186/s13054-021-03849-2. Crit Care. 2021. PMID: 34920738 Free PMC article. No abstract available.

Abstract

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission.

Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes.

Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47).

Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.

Keywords: COVID-19; Coronavirus; Mechanical ventilation; SARS-CoV-2; Ventilatory ratio.

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Conflict of interest statement

The authors have disclosed that they do not have any conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of patient screening and enrollment. A total of 1118 patients were followed-up until hospital discharge or death. ECMO extracorporeal membrane oxygenation; ICU intensive care unit; SARS-CoV-2 severe acute respiratory syndrome coronavirus 2
Fig. 2
Fig. 2
Comparison between ICU admission and day 3 stratified by survival status. Horizontal lines of the boxplots show median values, while the upper and lower lines depict the interquartile range. Dots depict values for each patient. Delta partial pressure of oxygen in arterial blood (PaO2) did not vary between survivor and non-survivor patients (A), while partial pressure of carbon dioxide in arterial blood (PaCO2) (B), the ventilatory ratio (C), platelets count (D), serum creatinine (E), and D-dimer (F) significantly differed
See this image and copyright information in PMC

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